Individual
LISA MICKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
725 VOLVO PKWY STE 102, CHESAPEAKE, VA 23320-1621
(757) 842-4110
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 686-3500
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101282278
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2021
Last updated
07/08/2024
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